Abstracts

Rationale: Seizure is the third most common school emergency. Seizure therapy at the time of occurrence decreases the severity of seizures and Emergency Department visits. Prior studies found that only 67% of school nurses report feeling confident in seizure management. Concerns about privacy and legal issues have been identified as barriers to the use of rectal diazepam in schools. School nurses have not been surveyed regarding intranasal (IN) midazolam and vagal nerve stimulator (VNS) magnet use. The purpose of this pilot study is to assess school nurses’ perceptions of barriers to optimal management of seizures in schools.Methods: The Ohio Association of School Nurses (n=450) were sent an electronic survey evaluating their comfort, knowledge, and practice, as well as their school districts’ policies regarding seizure management. School district was stratified by urban, suburban and rural. Data was analyzed using descriptive statistics, Fisher’s Exact Test, and linear regression.Results: 83 school nurses completed the survey, and all reported caring for a child seizing in school. The cohort had a mean of 15.1 years’ experience as a school nurse. Many, 44/82 (53.7%), had an advanced degree and the mean seizure knowledge was 91.0% (+/- 0.93). The majority “agree” or “strongly agree” that they can identify a seizure 80/82 (97.6%), feel comfortable with the definition of and can properly handle cluster seizures 55/82 (67.1%), and feel comfortable giving rectal diazepam 67/80 (83.8%). However, fewer “agree” or “strongly agree” that they feel comfortable giving IN midazolam 50/79 (63.3%) or swiping a VNS magnet 36/76 (47.4%). Only 47/83 (56.6%) felt they had enough information about a specific child’s seizures and their management. Nurses were more likely to be available at the time of a seizure in rural (17/20) vs suburban (21/34) or urban (8/25) school (p=0.001). Most school policies permit RN’s to give rectal diazepam, 79/83 (95.2%) and IN midazolam 72/83 (86.8%), but less frequently allow other staff to give these medications, 56/83 (67.5%) and 43/83 (51.8%), respectively. School nurses reported they feel confident that school staff can accurately identify a seizure, 50/83 (60.2%). School policies required a child to be transported to the ED for any convulsive seizure in 10/82 (12.2%) and if a rescue medication was given in 32/83 (38.6%). Parents were not permitted to decline transport to the ED in 13/83 (15.7%).Conclusions: School nurses are comfortable managing seizures in the school setting. However, a specific seizure plan for each child and enhanced education on IN midazolam and VNS magnet use are needed. A major barrier to the optimal management of seizures in urban schools is inadequate availability of trained personnel to identify seizures and administer treatment. Additionally, there are variable beliefs and policies about the need to transport a child to the ED if they have a seizure at school. Uniform recommendations and expansion of resources and approaches for the management of seizures in school are needed to optimize care for these children.